Online Classes ONLY Immunization Waiver

In submitting this form, I affirm that I am registering for ONLY online classes for:

Semester*

Year*

I understand, for each semester for which I am requesting the exemption, I must complete a new form, sign and either submit online, fax, or bring it to the Registration Office in order to continue to be exempt from the immunization requirements related to full-time enrollment.

Check immunization status in GoldLink to verify that proof has been received.

Log into GoldLink using your username and password.
Click the "My Student Info" tab.
Under the "Registration Tools" box, choose Immunization Status.

If necessary requirements are not met, the one semester waiver will not be approved.

Student Name*

First NameLast Name

E#*

E-mail*

Phone Number*

Area CodePhone Number

Date:*

MonthDayYear

I certify that the information is correct and my E Number acts as my electronic signature.*

Questions regarding immunization requirements: contact University Health Center (423) 439-439-4225.
Questions regarding completing this waiver: contact Registration Help Desk (423) 439-5584.